of Gravity Change 30% Increased in Total Blood Volume Symbiont Relationship

Center

Complications and Treatment Options in the Remote Setting.

Spontaneous

Abortion/Miscarriage Ectopic Pregnancy Bleeding Other Origin

Definition- Developing Fetus implants in the falopian tube instead of in the Uterus Treatment- Confirm diagnosis by ultra sound and lab testing

If diagnosis is ruptured, or suspected ruptured

ectopic pregnancy, be prepared to treat HYPOVOLEMIC SHOCK. Rapid transport to nearest O.R.

Hypertensive

Disorders Bleeding Problems Malpresentations Dystocias Amniotic Fluid Embolism

 Gestational
mild severe

Hypertension Preeclampsia
Eclampsia
HELLP

Syndrome

Gestational

Hypertension but spilling protein into urine Treatment depends on severity

 Control

BP Eclampsia

Hydralazine Labetolol

Prevent

Magnesium Sulfate

The

Cure For Preeclampsia is Deliver The Baby

The only difference between Preeclampsia and Eclampsia

SEIZURE
The Cure for Eclampsia is
Immediately

DELIVER THE BABY

BUT, in the meantime

 Magnesium

Sulfate Benzodiazapines Barbituates Morphine

Rapid Transport

Deliver the Baby

YIKES

 H E L L P-

hemolysis elevated liver enzymes

low
platelets

2% of patients with PEC will develop H.E.L.L.P. A few patients will develop H.E.L.L.P. without having signs or symptoms of PEC

 Support

Vital Signs Treat HTN Seizure prophylaxis

The only CURE for HELLP is

DELIVER THE BABY

Please check your company protocols for proper medication administration

 Placenta

Previa Placenta Abruption Vasa Previa Uterine Rupture Normal?

Partial
Mild

Moderate

Full
Completely covers cervical OS

Placenta is completely covering cervical OS May have antepartum bleeding and/or acute hemorrhage Cannot deliver vaginally O.R. Emergency

Mom and baby can exsanguinize rapidly Treat for HYPOVOLEMIC SHOCK

 Different

from Previa

Pain

Mild
May happen at any time during pregnancy Mild spotting

May be undiagnosed

Very Painful Hemorrhage externally Hemorrhage internally Exsanguination of mother and baby May not be compatible with life if OR not readily available Treat for SHOCK

Velamentous insertion of Fetal vessels across cervical OS The treatment is Dont Stir the Pot If ROM or vaginal manipulation, immediate and rapid fetal exsanguination will occur

Support maternal Hemodynamics Rapid transport

O.R.

EMERGENCY

Pt needs emergent surgery

Support

VS and treat for Shock May not be compatible with life in prolonged transport setting

Complete

Footling Frank

 Feet

Tucked down by buttocks May deliver vaginally High risk for cord prolapse Tocolytics and transport
Cephalic Dystocia

Most

Common in Preterm OR Urgently Tocolytics and Transport

May

Deliver Vaginally High Risk Cord Prolapse Tocolytics and Transport

Cephalic Dystocia

Head has delivered but the baby is stuck

McRoberts Maneuver: Sharp flexion of the

maternal hips Suprapubic pressure: attempt to dislodge the shoulder from behind the pubic bone Rubin Maneuver: Place pressure on the presenting shoulder to push it inward and decrease the diamter of the presentation Woods Corkscrew maneuver: Apply pressure behind the posterior shoulder to rotate the baby and dislodge the anterior shoulder
Fracturing the fetal clavical

 Manifested

by Late Signs and Symptoms of fetal and maternal shock Most patients do not live past CPR Treat For Shock Treat Respiratory Distress Treat Cardiac arrest

Toco- picks up ctxs, place on the apex of the fundus

An external Toco can only measure

frequency and duration NOT strength An IUCP is required to measure strength, we dont have the adapter for this

US- place wherever you can pick up the babys heart rate the best. A reassuring 20 minute strip will include two accelerations and normal variability

Accelerations- two pink boxes or more for at least two boxes in length as a guideline Accelerations = happy baby
i.e. baby is taking a

Decels
Early- starts before

the peak of the ctx Late- starts after the peak of the ctx Variable is a combination of both

little jog around the block and heart rate increases

Early decels usually require no treatment. They can be caused by head compression at the end stages of labor. If they are deep or prolonged, consider repositioning and oxygen

Late decels indicate fetal hypoxia. As the tracing loses its variability, the fetus is become more hypoxic and acidotic. Late decels always require intervention. Oxygen, reposition, fluid bolus?

120-160

How bumpy is the tracing? Moderate variability is normal Is is marked? Decreased? Beat to beat variability only accessible through FSE

Tachycardia Maternal fever CNS immaturity Maternal medications, drug use

Bradycardia
Fetal hypoxia Maternal drug use

What we do to momwe also do to baby Move mommove baby

Jake Feb 1,2011 6lbs 12oz 19.5 inches

Blueprints Fifth edition Ostetrics & Gynecology. Tamara L. Callahan/ Aaron B Caughey: Wolters Kluwer/ Lippincott Willaims & Wilkins 2009 Williams Manual of Obstetrics Pregnancy Complications twenty-second edition Kenneth Jleveno, F. Gary Cunninggham, James M. alexander, Steven L. Bloom, Brian M. Casey, Jodi S. Dashe, Jeanne S. Sheffield, Scott W. Robers: McGraw Hill Medical 2007 American Congress of Obstetricians and Gynecologists: http://www.acog.org